Absolute Resting Energy Expenditure Research Articles

Resting Energy Expenditure Is Not Altered in Children and Adolescents with Obesity. Effect of Age and Gender and Association with Serum Leptin Levels.

In children and adolescents, obesity does not seem to depend on a reduction of resting energy expenditure (REE). Moreover, in this young population, the interactions between either age and obesity or between age and gender, or the role of leptin on REE are not clearly understood. To compare the levels of REE in children and adolescents we studied 181 Caucasian individuals (62% girls) classified on the basis of age- and sex-specific body mass index (BMI) percentile as healthy weight (n = 50), with overweight (n = 34), or with obesity (n = 97) and in different age groups: 8–10 (n = 38), 11–13 (n = 50), and 14–17 years (n = 93). REE was measured by indirect calorimetry and body composition by air displacement plethysmography. Statistically significant differences in REE/fat-free mass (FFM) regarding obesity or gender were not observed. Absolute REE increases with age (p < 0.001), but REE/FFM decreases (p < 0.001) and there is an interaction between gender and age (p < 0.001) on absolute REE showing that the age-related increase is more marked in boys than in girls, in line with a higher FFM. Interestingly, the effect of obesity on absolute REE is not observed in the 8–10 year-old group, in which serum leptin concentrations correlate with the REE/FFM (r = 0.48; p = 0.011). In conclusion, REE/FFM is not affected by obesity or gender, while the effect of age on absolute REE is gender-dependent and leptin may influence the REE/FFM in 8–10 year-olds.

Effects of Resistance Training With or Without Protein Supplementation on Body Composition and Resting Energy Expenditure in Patients 2-7Years PostRoux-en-Y Gastric Bypass: a Controlled Clinical Trial.

Resistance training (RT) and adequate protein intake are recommended as strategies to preserve fat-free mass (FFM) and resting metabolic demand after bariatric surgery. However, the effect of both interventions combined in the late postoperative period is unclear. This study investigated the effects of RT, isolated and combined with protein supplementation, on body composition and resting energy expenditure (REE) in the late postoperative period of Roux-en-Y gastric bypass (RYGB). This controlled trial involved patients who were 2-7years postRYGB. Participants were partially matched on body mass index (BMI), age, sex, and years after surgery, and divided into four groups, placebo maltodextrin (control [CON]; n = 17), whey protein supplementation (PRO; n = 18), RT combined with placebo (RTP; n = 13), and RT combined with whey protein supplementation (RTP + PRO; n = 15)-considering the participants who completed the protocol. REE was measured by indirect calorimetry and body composition by multifrequency electrical bioimpedance. Participant characteristics (40.3 ± 8.3years old; average BMI 29.7 ± 5.3kg/m2; 88.9% females) were similar among groups. The RTP+PRO group showed an increase of 1.46 ± 1.02kg in FFM and 0.91 ± 0.64kg in skeletal muscle mass (SMM), which was greater than the equivalent values in the CON group (- 0.24 ± 1.64kg, p = 0.006 and - 0.08 ± 0.96kg, p = 0.008, respectively). There was no significant time-by-group interaction for absolute or relative REE. Combined RT and adequate protein intake via supplementation can increase FFM and SMM in the late postoperative period without changing REE. These associated strategies were effective in improving muscle-related parameters and potentially in improving the patients' physical function.

Comparison of Measured and Estimated Resting Energy Expenditure in Adolescents and Young Adults With Severe Obesity Before and 1 Year After Sleeve Gastrectomy.

Introduction: Resting energy expenditure (REE) is often evaluated in adults and adolescents with obesity to estimate caloric requirements when advising dietary changes. However, data are lacking regarding the accuracy of methods used to clinically assess REE in adolescents with severe obesity. Moreover, there are no data regarding the effects of sleeve gastrectomy (SG) on REE in adolescents. We evaluated the accuracy and error rate between estimated and measured REE in adolescents with severe obesity and changes in REE following (SG).Materials and Methods: Cross-sectional study (CSS): 64 adolescents and young adults, 14–22 years old, with moderate to severe obesity were enrolled. We measured REE (mREE) by indirect calorimetry and estimated REE (eREE) using Derumeaux (Deru), Mifflin-St Jeor (MS), Harris Benedict (HB), and World Health Organization (WHO) equations. DXA was used to determine body composition. Bland Altman analysis evaluated agreement between eREE and mREE. Longitudinal study: 12 subjects had repeat indirect calorimetry and DXA 1 year after SG. Longitudinal analysis was used to assess changes in REE and body composition.Results: CSS: Median BMI was 45.2 kg/m2 and median age was 18.0 (16.3–19.9) years. mREE correlated strongly with eREE . Bland Altman analysis demonstrated that only a few points were beyond the 1.96 SD limit of disagreement. However, there was considerable overestimation of mREE by most equations. Longitudinal Study: In the subset that underwent SG, after 12-months, absolute REE decreased from 1709 (1567.7–2234) to 1580.5 (1326–1862.5) Calories (p = 0.002); however, the ratio of REE/Total Body Weight (TBW) increased from 13.5 ± 2.3 at baseline to 15.5 ± 2.2 at 1 year (p = 0.043). When evaluating parameters affecting % total weight loss, we found that it correlated positively with REE/TBW at 12 months (R = 0.625; p = 0.03) and negatively with % fat mass at 12 months (R = −0.669; p = 0.024).Discussion: In adolescents with moderate-severe obesity, despite a correlation between mREE using indirect calorimetry and eREE using the Deru, MS, HB, and WHO equations, there is significant over-estimation of REE at the individual level, challenging their clinical utility. One year after SG, REE/TBW increased and strongly correlated with % total weight loss in adolescents.

Estimate of Resting Energy Expenditure by DXA in Boys of Different Nutritional Statuses

Abstract Aim: to estimate the resting energy expenditure (REE) of organ tissue components using Dual Energy x-ray Absorptiometry (DXA) in pubertal boys. The mass of components and REE were compared among groups of different nutritional statuses. Methods: a sample of 278 boys (13.7 ± 2.4 years old) was grouped according to BMI nutritional status for Brazilian children and adolescents1 such as Underweight (UW), Normal weight (NW), Overweight (OW), and Obese (OB). The REE of organ tissue components given by DXA was calculated using specific models for skeletal muscle tissue (SMT), adipose tissue (AT), bone tissue (BT) and residual tissue (RT) based on previous reports. The absolute and relative REE (REEDXA) of each component were statistically compared among groups. Results: No differences of total REEDXA were found among nutritional groups (F(3, 274)=0.071, p=0.976). When, however, specific REE was considered per component, differences were found for BT and REEBT between NW-OW (p=0.003) and NW-OB (p=0.048); in AT and REEAT for all the groups (p<0.001), except between UW-NW (p=1.000); in RT and REERT between NW-OB (p=0,022) and SMT and REESMT (p=0,039). Greater proportions of organ tissue of RT and high metabolic rates, were observed in the UW group (78.3%) in comparison to the OB group (60.7%). Conclusion: This approach provides a new opportunity to examine energy metabolism for individual differences of pediatric populations. It is an applicable strategy both to prescribe exercises and to administer diets to this population, as it reveals the magnitude of heat-producing body components.

Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study

Background/Objectives:The MATADOR (Minimising Adaptive Thermogenesis And Deactivating Obesity Rebound) study examined whether intermittent energy restriction (ER) improved weight loss efficiency compared with continuous ER and, if so, whether intermittent ER attenuated compensatory responses associated with ER.Subjects/Methods:Fifty-one men with obesity were randomised to 16 weeks of either: (1) continuous (CON), or (2) intermittent (INT) ER completed as 8 × 2-week blocks of ER alternating with 7 × 2-week blocks of energy balance (30 weeks total). Forty-seven participants completed a 4-week baseline phase and commenced the intervention (CON: N=23, 39.4±6.8 years, 111.1±9.1 kg, 34.3±3.0 kgm−2; INT: N=24, 39.8±9.5 years, 110.2±13.8 kg, 34.1±4.0 kgm−2). During ER, energy intake was equivalent to 67% of weight maintenance requirements in both groups. Body weight, fat mass (FM), fat-free mass (FFM) and resting energy expenditure (REE) were measured throughout the study.Results:For the N=19 CON and N=17 INT who completed the intervention per protocol, weight loss was greater for INT (14.1±5.6 vs 9.1±2.9 kg; P<0.001). INT had greater FM loss (12.3±4.8 vs 8.0±4.2 kg; P<0.01), but FFM loss was similar (INT: 1.8±1.6 vs CON: 1.2±2.5 kg; P=0.4). Mean weight change during the 7 × 2-week INT energy balance blocks was minimal (0.0±0.3 kg). While reduction in absolute REE did not differ between groups (INT: -502±481 vs CON: −624±557 kJ d−1; P=0.5), after adjusting for changes in body composition, it was significantly lower in INT (INT: −360±502 vs CON: −749±498 kJ d−1; P<0.05).Conclusions:Greater weight and fat loss was achieved with intermittent ER. Interrupting ER with energy balance ‘rest periods’ may reduce compensatory metabolic responses and, in turn, improve weight loss efficiency.

Metabolism and Exercise During Youth.

Three publications were selected based on the strength of the research questions, but also because they represent different research designs that are used with varying degrees of frequency in the pediatric literature. The first, a prospective, longitudinal cohort observation study from 7 to 16 years with girls and boys reports an intrinsic reduction in absolute resting energy expenditure after adjustment for lean mass, fat mass, and biological maturity. The authors suggest this could be related to evolutionary energy conservation, but may be problematic now that food energy availability is so abundant. The second focuses on the effect of acute exercise on neutrophil reactive oxygen species production and inflammatory markers in independent groups of healthy boys and men. The authors suggested the boys experienced a "sensitized" neutrophil response stimulated by the exercise bout compared with the men; moreover, the findings provided information necessary to design future trials in this important field. In the final study, a dose-response design was used to examine titrated doses of high intensity interval training on cardiometabolic outcomes in adolescent boys. While the authors were unable to identify a recognizable dose-response relationship, there are several design strengths in this study, which was probably underpowered.

Evidence for energy conservation during pubertal growth. A 10-year longitudinal study (EarlyBird 71).

Diabetes is closely linked to obesity, and obesity rates climb during adolescence for reasons that are not clear. Energy efficiency is important to obesity, and we describe a temporary but substantial fall in absolute energy expenditure, compatible with improved energy efficiency, during the rapid growth phase of puberty. In a longitudinal cohort study lasting 10 years, we measured voluntary energy expenditure as physical activity (PA) by accelerometry, involuntary energy expenditure as resting energy expenditure (REE) by oxygen consumption, body mass index (BMI) and body composition by dual energy X-ray absorptiometry annually on 10 occasions from 7 to 16 years in the 347 children of the EarlyBird study. We used mixed effects modelling to analyse the trends in REE and their relationship to BMI, lean mass (LM), fat mass (FM), age, PA and pubertal stage. Relative REE and total PA fell during puberty, as previously described, but the longitudinal data and narrow age-range of the cohort (s.d.±4m) revealed for the first time a substantial fall in absolute REE during the period of maximum growth. The fall became clearer still when adjusted for FM and LM. The fall could not be explained by fasting insulin, adiponectin, leptin, luteinising hormone or follicle stimulating hormone. There appears to be a temporary but substantial reduction in energy expenditure during puberty, which is unrelated to changes in body composition. If it means higher energy efficiency, the fall in REE could be advantageous in an evolutionary context to delivering the extra energy needed for pubertal growth, but unfavourable to weight gain in a contemporary environment.

Is Obesity Associated with Altered Energy Expenditure?

Historically, obese individuals were believed to have lower energy expenditure (EE) rates than nonobese individuals (normal and overweight), which, in the long term, would contribute to a positive energy balance and subsequent weight gain. The aim of this review was to critically appraise studies that compared measures of EE and its components, resting EE (REE), activity EE (AEE), and diet-induced thermogenesis (DIT), in obese and nonobese adults to elucidate whether obesity is associated with altered EE. Contrary to popular belief, research has shown that obese individuals have higher absolute REE and total EE. When body composition (namely the metabolically active component, fat-free mass) is taken into account, these differences between obese and nonobese individuals disappear, suggesting that EE in obese individuals is not altered. However, an important question is whether AEE is lower in obese individuals because of a decrease in overall physical activity or because of less energy expended while performing physical activity. AEE and DIT could be reduced in obese individuals, mostly because of unhealthy behavior (low physical activity, higher intake of fat). However, the current evidence does not support the hypothesis that obesity is sustained by lower daily EE or REE. Future studies, comparing EE between obese and nonobese and assessing potential physiologic abnormalities in obese individuals, should be able to better answer the question of whether these individuals have altered energy metabolism.

Metabolism and Exercise During Youth.

Three publications were selected based on the strength of the research questions, but also because they represent different research designs that are used with varying degrees of frequency in the pediatric literature. The first, a prospective, longitudinal cohort observation study from 7 to 16 years with girls and boys reports an intrinsic reduction in absolute resting energy expenditure after adjustment for lean mass, fat mass, and biological maturity. The authors suggest this could be related to evolutionary energy conservation, but may be problematic now that food energy availability is so abundant. The second focuses on the effect of acute exercise on neutrophil reactive oxygen species production and inflammatory markers in independent groups of healthy boys and men. The authors suggested the boys experienced a “sensitized” neutrophil response stimulated by the exercise bout compared with the men; moreover, the findings provided information necessary to design future trials in this important field. In...

Resting Energy Expenditure (REE) in Six- to Seventeen-Year-Old Japanese Children and Adolescents

Accurate estimation of resting energy expenditure (REE) in children and adolescents is important to establish estimated energy requirements for the Japanese population. Our objectives were 1) to determine the REE of 6- to 17-y-old Japanese children and adolescents by indirect calorimetry in order to estimate energy expenditure for this group, 2) to compare measured REE with predicted REE to determine the accuracy of predictive equations of REE for Japanese children and adolescents, and 3) to derive new predictive equations for REE for Japanese children and adolescents based on measured REE. REE was measured in 221 Japanese children and adolescents, aged 6 to 17 y old (113 boys and 108 girls) using a ventilated indirect calorimeter. Anthropometric and body composition measurements were also performed. REE expressed as absolute values increased with age in both genders, and there was a significant difference between genders in the 12-17 y age group. REE was strongly correlated with body weight (BW) and fat-free mass (FFM). REE adjusted for BW or FFM decreased with age in both genders, and a gender difference was still observed in the 12-17 y age group after this adjustment. The highest accuracy of prediction was achieved using the Dietary Reference Intake for Japanese (1969) for boys and the Molnar equation for girls. Step-down multiple regression analysis was carried out using either a combination of age, gender, BW, and height, or a combination of age, gender, FFM, and fat mass (FM). The predictive equation accounted for 75% (R2) and 76% of the variance, respectively. In conclusion, absolute REE increased and REE adjusted for BW or FFM decreased with age. The major determinant of REE was FFM, but significant gender differences were observed in the 12-17 y range for both absolute REE and adjusted REE.

Increased resting energy expenditure by fat-free mass in children and teenagers with constitutional leanness

To compare the resting energy expenditure (REE) and the REE/Fat-free-mass (FFM) quotient in children with constitutional leanness (CL) and children with normal body weight, and to describe the within-family clustering of CL. We have studied 18 children and teenagers with CL, 10 girls and 8 boys, and 18 gender and age matched normal controls, with the same pubertal stage. All were recruited from the outpatient pediatric clinic nutrition unit. None of the children with CL showed symptoms of chronic illness, they had normal laboratory results, they had a normal caloric food intake, and they did not agree with the DSM-IV-TR criteria for anorexia nervosa. We describe the body mass index (BMI) of children and their parents. The children were classified according to Cole's recently published BMI cut-offs for thinness: under 18.5 points in CL group, stable at least in the last year, and between 18.5 and 25 cutt-offs in the control group. The body composition was calculated by anthropometric methods (skinfold thickness measurements). In addition REE was measured using fasting indirect calorimetry. The CL group had a higher mean percentage of FFM, and a mean FM significantly less, relative to controls (p < 0.001). The average absolute REE was significantly lower in the CL group (1,106.55 ± 240.72 kcal) than the control group (1,353.33 ± 270.01 kcal/dia) (p < 0.01). However, the REE adjusted for FFM showed a mean significantly greater in the CL group (41.39 ± 2.26 kcal/kg FFM) (Mean confidence interval (CI) 95 %: 40.33-42.45) than the controls (37.37 ± 3.06 kcal/kg FFM) (Mean CI 95 %: 35.93-38.81) (p < 0.001). Finally, in the family study, the mean BMI of fathers of CL group was significantly lower (p < 0.01), but there were not any differences in the mean BMI of mothers. Among parents with BMI known, 8 of 35 parents of CL group had an BMI lower 18.5, and only 2 of 36 parents in the control group (p < 0.05). This increased energy expenditure-to-FFM ratio differentiates between CL and controls. These metabolic differences are probably genetically determined.

Energy expenditure and estimated caloric intake in asthmatic adolescents with excess body weight

Objective To measure resting energy expenditure (REE) and to estimate caloric intake of asthmatic adolescents with excess body weight and compare results with those groups of eutrophic asthmatic adolescents and non-asthmatic adolescents with excess body weight. Methods This cross-sectional study categorized 69 adolescents aged 10 to 18 y into three matched groups. Nutritional status was assessed using anthropometric and body composition measurements. Indirect calorimetry was used to measure energy expenditure, and caloric intake was estimated from dietary recalls. Results In each group, there were 23 adolescents (10 girls) aged 12.39 ± 2.40 y. Results for each group were as follows. For asthmatic adolescents with excess body weight, body mass index (BMI) was 24.83 ± 2.73 kg/m 2, REEs were 1550.24 ± 547.23 kcal/d and 27.69 ± 11.33 kcal · kg −1 · d −1, and estimated caloric intake was 2068.75 ± 516.66 kcal/d; for eutrophic asthmatic adolescents, BMI was 19.01 ± 2.10 kg/m 2, REEs were 1540.82 ± 544.22 kcal/d and 36.65 ± 15.04 kcal · kg −1 · d −1, and estimated caloric intake was 2174.05 ± 500.55 kcal/d; and for non-asthmatic adolescents with excess body weight, BMI was 25.35 ± 3.66 kg/m 2, REEs were 1697.24 ± 379.84 kcal/d and 28.18 ± 6.70 kcal · kg −1 · d −1, and estimated caloric intake was 1673.17 ± 530.68 kcal/d. Absolute REE values between groups were not statistically different, even after correction for lean mass and fat mass ( F = 0.186, P = 0.831). REE (kilocalories per kilogram per day) was significantly higher in the group of eutrophic asthmatic adolescents ( P = 0.016). Estimated caloric intake was greater than REE only in the group of adolescents with asthma. Conclusion The REE was not significantly different among groups, and REE (kilocalories per kilogram per day) was higher in the group of eutrophic asthmatic adolescents. Estimated caloric intake was greater than REE in the group of adolescents with asthma.

Beneficial changes in energy expenditure and lipid profile after eccentric exercise in overweight and lean women

The aim was to compare lean and overweight females in regard to the effects of eccentric exercise on muscle damage indices, resting energy expenditure (REE) and respiratory quotient (RQ) as well as blood lipid and lipoprotein profile. Lean and overweight females (deviated by their body mass index) performed an eccentric exercise session. Muscle damage, energy cost and lipid profile were assessed pre-exercise and up to 72 h post-exercise. After eccentric exercise (i) muscle damage indices were affected more in the overweight subjects compared with the lean subjects; (ii) the elevation of absolute and relative REE was larger and more prolonged in the overweight group compared with the lean group; (iii) after 24 h, RQ had significantly declined, with the overweight subjects exhibiting a larger reduction compared with the lean group; and (iv) the blood lipid profile was favorably modified, with the overweight group exhibiting more favorable responses compared with the lean group. The differences between the lean and the overweight subjects may be partly due to the fact that overweight individuals experienced greater muscle damage than lean individuals. Eccentric exercise may be a promising lifestyle factor to combat obesity and dyslipidemias.

Low Resting Energy Expenditure in Asians Can Be Attributed to Body Composition

To compare resting energy expenditure (REE) between Asians and whites after adjusting for fat-free mass measured with a two- or more-compartment model. Participants were 10 white men (28 +/- 3 years), 10 Asian men (30 +/- 4 years), 10 white women (22 +/- 4 years), and 11 Asian women (31 +/- 7 years). REE was measured with a ventilated hood system under strictly controlled conditions. Body composition was measured with a two-compartment model based on body mass (BM) and body volume (hydrodensitometry), a three-compartment model adding total body water (TBW) (deuterium dilution), and a four-compartment model incorporating bone mass (dual-energy X-ray absorptiometry (DXA)) as well. Lean BM in the trunk and in the extremities was assessed with DXA. All measurements were performed at Maastricht University. Measurements on Asian subjects were performed within 3 months after their arrival in the Netherlands. Absolute REE was lower in Asians (5.87 +/- 0.91 MJ/day) than in whites (7.00 +/- 1.11 MJ/day). There was no significant difference in REE between the two races after adjustment for fat-free mass. There were no significant differences in REE between Asians and whites after adjustment for differences in body composition based on a two- or more-compartment model.

Resting Energy Expenditure of Children and Adolescents Undergoing Hemodialysis

We compared the resting energy expenditure (REE) of clinically stable children and adolescents on hemodialysis with that of healthy individuals, to investigate whether the current energy recommendations from the National Kidney Foundation/Kidney Disease Outcomes Initiative (NKF/DOQI) are adequate. A cross-sectional study was conducted in 25 children and adolescents (15 male, SD 12.3 +/- 3.1 years old) undergoing hemodialysis (study group) under stable clinical conditions. Patients were pair-matched by sex and age with 25 healthy individuals (control group). The REE was measured by indirect calorimetry. Nutritional status was evaluated by body mass index Z-score, and growth deficit was evaluated by height-for-age Z-score. Body composition was assessed by dual-energy X-ray absorptiometry. The total energy expenditure (TEE) was estimated by multiplying the REE by the physical activity factor. The recommended dietary allowance (RDA) for daily energy intake was compared with the estimated TEE in the study group, considering children's age-specific height. All anthropometric parameters were significantly lower in the study group. Malnutrition and stunting were found in up to 56% and 60%, respectively, of the children in the study group. The absolute REE was significantly lower in the study group than in the control group (1,067 +/- 191 kcal/day vs 1,372 +/- 290 kcal/day, respectively, P < .01). However, when the REE was adjusted for its main determinant, ie, lean body mass, no significant difference was observed between groups (P = .12). In the study group, the RDA for energy was above the TEE in all age groups, and the mean percentage of RDA/TEE was 124.2% +/- 14.2%. Children and adolescents on hemodialysis had an important deficit of energy and protein stores. The similar adjusted REE found between hemodialysis patients and their matched healthy pairs suggests that under stable clinical conditions, the REE of these subjects is normal. Moreover, the energy recommendation set by he NKF/DOQI is appropriate for this population.

Effects of Roux-en-Y Gastric Bypass on Resting Energy Expenditure in Women

Bariatric surgery is the gold standard treatment for morbid obesity, but little is known about its effects on resting energy expenditure. Twenty-one women underwent anthropometric and resting energy expenditure (REE) measurements before and 3 months after bariatric surgery using the Roux-en-Y gastric bypass (RYGBP) technique developed by Capella. The patients experienced a significant reduction in body weight, body mass index, waist circumference, and waist-to-hip ratio (WHR). The cardiopulmonary variables oxygen uptake, carbon dioxide output, non-protein respiratory quotient, and heart rate all decreased, whereas oxygen pulse did not change significantly. Absolute REE showed a significant reduction 3 months postoperatively (2006.7 +/- 376.4 kcal/day to 1763.3 +/- 310.5 kcal/day), but no significant difference was found compared with REE relative to body weight (0.71 +/- 0.15 kcal kg(-1)h(-1) to 0.75 +/- 0.12 kcal kg(-1) h(-1)) or as percent of Harris-Benedict predicted REE (106.2 +/- 21.0% to 103.3 +/- 15.1%). In this study, bariatric surgery using the RYGBP technique (Capella) led to a significant decrease of body weight that decreased resting energy expenditure proportional to this weight loss, and to an increase in the utilization of fat as an energy substrate. It can be concluded that after 3 months, the Roux-en-Y gastric bypass surgery may provide significant metabolic benefits to morbidly obese women.

Body Composition and Resting Energy Expenditure in Patients Aged 11 to 21 Years With Spinal Cord Dysfunction Compared to Controls: Comparisons and Relationships Among the Groups

Objectives: To compare body composition in patients aged 11 to 21 years with spinal dysfunction due to spinal cord injury (SCI) and spina bifida (SB) vs able–bodied control (CTRL) and able–bodied overweight (OW) groups and to examine the relationships between resting energy expenditure (REE) and total lean mass (TLM) in the SCI, SB, CTRL, and OW groups.Methods: Two hundred fifteen subjects, including 85 CTRL, 31 OW, 33 SCI, and 66 SB, were evaluated. Body composition was estimated by dual energy x-ray absorptiometry (DXA). Measurements included height, weight, total lean mass (TLM), fat tissue mass (FTM), body mass index (BMI), BMI percentile (BMI%tile), and %fat. Resting energy measurements were obtained in fasting subjects with an open-circuit indirect calorimeter.Results: There were gender differences in height, weight, BMI, TLM, fat mass,%fat, and REE. The REE in the SCI and SB groups was significantly different from that in the CTRL and OW groups, but no significant difference was found between the SCI and SB groups. The SB group had significantly higher REE/TLM ratios than did the other groups. The %fat was significantly higher in the SB and OW groups as compared to the CTRL and SCI groups. TLM was significantly higher in CTRL and OW groups as compared to SCI and SB groups, with the lowest TLM found in the SB group.Conclusion: Patients aged 11 to 21 years with SB or SCI have significant lean tissue mass deficits by DXA as compared to able–bodied CTRL and OW groups, with the greatest deficits in total lean mass measured in SB. The absolute REE values were significantly reduced in both SCI and SB groups in association with their lean tissue deficits. Interestingly, REE/TLM ratios were remarkably constant in the CTRL, OW, and SCI groups but significantly elevated in the SB group. One would expect an even greater degree of adiposity in the SB group if their REE/TLM ratios were not elevated relative to those without congenital paralysis.

Resting energy expenditure is not increased in mildly hyperglycaemic obese diabetic patients

Resting energy expenditure (REE) is believed to be increased in type 2 diabetes, an increase that is associated with deteriorating glucose tolerance during its development. Meanwhile, insulin resistance, a state linked to obesity and observed in all type 2 diabetic patients, is associated with reduced REE. Our aim was to compare REE in obese patients with and without diabetes. REE, body composition (total body water, density, percentage fat and fat-free mass: 3-compartment model) and metabolic control were assessed in fifty obese Caucasian patients with diabetes (glycated haemoglobin level 7.6 (SD 1.5) %) and fifty obese patients who were non-diabetic. Despite being more overweight and younger, obese non-diabetic patients had an absolute REE (7.73 (SD 1.44) v. 8.12 (SD 1.37) MJ; P=0.17) and percentage fat-free mass similar to those of obese diabetic patients. Even when adjusted for differences in body composition, REE remained similar in both groups. Furthermore, REE (absolute and adjusted) was unaffected by both glucose level and control (glycated haemoglobin), with fat-free mass being the only determinant of REE. We conclude that REE is not necessarily increased by the presence of diabetes in obese people.

Nutritional status and dietary patterns in disabled people

Background and aim Obesity, cardiovascular diseases, diabetes and osteoporosis are the most frequent pathologies among people with a severe reduction of physical activity. The impairment in nutritional status, consequent to quantitative and qualitative inadequacy of diet, could be one of the first steps in the development of co-morbidities in disabled subjects. In order to evaluate this hypothesis we investigated the nutritional status and the food intake in patients with physical or mental disabilities. Methods and results Thirty-seven disabled subjects (24 with exclusively physical inactivity and 13 with mental retardation and physical inactivity) mean age 33.5±9.2 years and 25 healthy subjects (mean age 31.0±9.3 years) were enrolled. Anthropometric measurements, indirect calorimetry, dual-energy X-ray absorptiometry, dietary intake and biochemical parameters were collected for each subject. Forty percent of disabled were overweight and 14% were obese. Fat free mass (FFM) and bone mineral content (BMC) was lower and fat mass (FM) was higher than able-bodied control. Absolute resting energy expenditure (REE) was lower in disabled subjects, but this difference disappeared when REE was normalized to FFM. Dietary intake resulted unbalanced (16%, 31%, 50% of total daily energy intake derived from protein, lipid and carbohydrate respectively) with a distribution of dietary fatty acid quite far from the recommended ratio [3.1(SFA):4.1(MUFA):1.0(PUFA)] and an excessive consumption of simple carbohydrates (mean intake 17.5±4.9%). Insufficient intake of fibre, iron, calcium, potassium and zinc was also found. Finally, alterations in the cholesterol profile were evident in more than one third of the disabled subjects, whereas fasting glucose intolerance was evident in one fourth. Conclusion This study shows a consistent nutritional status impairment in disabled patients resulting in an reduction of FFM and BMC, in an over-representation of FM and in a number of biochemical risk factors for cardiovascular disease. The altered nutritional status is counterparted by a widespread inadequacy of dietary patterns. This nutritional and dietary impairment occurs both in subjects with mental and physical diseases.

Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women.

ObjectiveTo compare the effects of isocaloric, energy-restricted very low-carbohydrate ketogenic (VLCK) and low-fat (LF) diets on weight loss, body composition, trunk fat mass, and resting energy expenditure (REE) in overweight/obese men and women.DesignRandomized, balanced, two diet period clinical intervention study. Subjects were prescribed two energy-restricted (-500 kcal/day) diets: a VLCK diet with a goal to decrease carbohydrate levels below 10% of energy and induce ketosis and a LF diet with a goal similar to national recommendations (%carbohydrate:fat:protein = ~60:25:15%).Subjects15 healthy, overweight/obese men (mean ± s.e.m.: age 33.2 ± 2.9 y, body mass 109.1 ± 4.6 kg, body mass index 34.1 ± 1.1 kg/m2) and 13 premenopausal women (age 34.0 ± 2.4 y, body mass 76.3 ± 3.6 kg, body mass index 29.6 ± 1.1 kg/m2).MeasurementsWeight loss, body composition, trunk fat (by dual-energy X-ray absorptiometry), and resting energy expenditure (REE) were determined at baseline and after each diet intervention. Data were analyzed for between group differences considering the first diet phase only and within group differences considering the response to both diets within each person.ResultsActual nutrient intakes from food records during the VLCK (%carbohydrate:fat:protein = ~9:63:28%) and the LF (~58:22:20%) were significantly different. Dietary energy was restricted, but was slightly higher during the VLCK (1855 kcal/day) compared to the LF (1562 kcal/day) diet for men. Both between and within group comparisons revealed a distinct advantage of a VLCK over a LF diet for weight loss, total fat loss, and trunk fat loss for men (despite significantly greater energy intake). The majority of women also responded more favorably to the VLCK diet, especially in terms of trunk fat loss. The greater reduction in trunk fat was not merely due to the greater total fat loss, because the ratio of trunk fat/total fat was also significantly reduced during the VLCK diet in men and women. Absolute REE (kcal/day) was decreased with both diets as expected, but REE expressed relative to body mass (kcal/kg), was better maintained on the VLCK diet for men only. Individual responses clearly show the majority of men and women experience greater weight and fat loss on a VLCK than a LF diet.ConclusionThis study shows a clear benefit of a VLCK over LF diet for short-term body weight and fat loss, especially in men. A preferential loss of fat in the trunk region with a VLCK diet is novel and potentially clinically significant but requires further validation. These data provide additional support for the concept of metabolic advantage with diets representing extremes in macronutrient distribution.